Professionalism, regulation, and the market: impact on accountability for quality of care.
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This paper examines the interplay of professionalism, regulation, and the market in shaping accountability on the part of hospitals, physicians, and health plans. We pay particular attention to the role of accreditation. We review the development of accountability and examine its recent evolution in the context of changing information technology, consumer demands, the decline of the staff- and group-model HMO, and the reemergence of health care cost inflation. The market is emerging as the dominant influence on accountability; this development will require changes in the roles and structure of regulation, professionalism, and accreditation in assuring accountability. (+info)
Preventing errors in the outpatient setting: a tale of three states.
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Although error in medicine has received sustained policy attention recently, the problem of error in the outpatient setting has been relatively neglected. In this paper we review what is known about the incidence and nature of error-related adverse events in physicians' offices, ambulatory care facilities, and surgicenters. We then analyze policies to improve outpatient safety in New Jersey, New York, and Florida, three states that took very different paths toward this goal. Their experience suggests that accreditation, combined with particular attention to ensuring anesthesia safety, can improve quality of care for outpatients. These actions are best accomplished through proactive legislation and the development of regulations, rather than reactive responses to adverse events. (+info)
Student performance on the Comprehensive Osteopathic Medical Licensing Examination-USA level 2 following a clinical evaluation, feedback, and intervention program.
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The purpose of this study was to examine student performance on the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) level 2 examination following a clinical evaluation, feedback, and intervention program. Students who completed their core clinical training (year 3) at the Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania, returned to the campus for a weeklong series of clinical science testing. Their performance in this program was compared to their performance on COMLEX-USA level 2 administered by the National Board of Osteopathic Medical Examiners approximately 3 months later. The authors analyzed other student data (Medical College Admission Test scores, grade point averages, and COMLEX-USA level 1 scores) to identify the relationship between these variables and the students' success (or failure) on COMLEX-USA level 2. Using a correlation approach, the authors found a relationship between COMLEX-USA levels 1 and 2 as well as between the preparation week and COMLEX-USA level 2, and that the significant difference in the results of the "at-risk" students continues in the COMLEX-USA level 2 performance. Further, the intervention used with students performing at less-than-satisfactory levels in the preparation program was successful in improving the performance of this group to a level equal to that of the second decile, thus increasing the likelihood that these students will pass the COMLEX-USA level 2 examination. (+info)
Good medical practice: guidance for occupational physicians.
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Following a catalogue of serious, highly publicized medical misdemeanours, the General Medical Council (GMC) has introduced plans for a new system of medical licensing in the UK called 'revalidation'. Under this, the onus will fall on individual doctors, including occupational physicians, to demonstrate their continuing fitness to practice. Doctors will need to show that they meet basic minimum standards in terms of the care they provide, their own continuing professional development, and other aspects of professional life like probity and ethical behaviour. As part of the process, the Faculty of Occupational Medicine, Royal College of Physicians, has produced its own guidance on good medical practice for occupational physicians, following an extensive consultation exercise. This paper summarizes the background to the initiative, the development process and the standards that have been recommended to aid professional accountability. (+info)
Relationship of osteopathic medical licensure examinations with undergraduate admission measures and predictive value of identifying future performance in osteopathic principles and practice/osteopathic manipulative medicine courses and rotations.
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Two hundred sixty-five students from four classes at one school of osteopathic medicine were studied to determine the correlation between several frequently used premedical admission criteria to predict performance on the early and current versions of the osteopathic medical licensure examinations. Further analysis evaluated the predictive value of the examination of the National Board of Osteopathic Medical Examiners (NBOME) and its successor, the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) in determining subsequent performance in the ascending levels of the examination sequence, as well as to predict performance in the courses and rotations of osteopathic principles and practice (OPP) and osteopathic manipulative medicine (OMM). This study also investigated the relationship between the early and later parts of the osteopathic medical licensure examinations. Analysis showed that of all premedical parameters, only the Medical College Aptitude Test score was positively correlated with performance on COMLEX-USA. In addition, a positive correlation was demonstrated between the performance in either Level 1 of COMLEX-USA or in the earlier form of the NBOME examination Part I and subsequent performance on the current Level 2 of COMLEX-USA or the old NBOME Part II. Finally, analysis indicated that COMLEX-USA predicted performance in OPP knowledge and skills. (+info)
Acupuncture in Nevada, second report.
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The State of Nevada has now given its fourth series of acupuncture licensing examinations. In all, 62 candidates have taken examinations. Licenses have been granted to 27 persons as master acupuncturists (Doctors of Traditional Chinese Medicine or Doctors of Acupuncture) and to 6 as Acupuncture Assistants. At present, 4 acupuncturists practice in the Reno area and 13 in Las Vegas. (+info)
Specialist registration: a critical look at the proposals of the Merrison report.
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In the general euphoria over the many views in the Merrison Report that the profession welcomed too little attention has been paid to what has been said about specialist registration. The report contains several basic confusions and a serious misunderstanding of the nature of specialist medical training and practice. It makes several cardinal errors in thinking that some notorious problems related to NHS staffing are also related to a lack of an effective specialist register, and it shows how the creation of such a register would largely destroy the authority of the colleges and faculties. Nowhere in the report is there any convincing argument to show that specialist registration would confer advantages sufficient to outweigh the disadvantages. To let specialist registration in the UK slip in on the irrelevant coat tails of EEC requirements would be a grave dereliction of the long-term interests of medical practice and patient care. The General Medical Council is holding a conference in which this topic is to be discussed on 24 February 1976 and it is still not too late for the profession to think again on this topic. (+info)
What should a suspended doctor do when his actions could save a patient's life?
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Suspension from duty is becoming an increasing threat for medical practitioners. While under suspension a doctor may, in extreme circumstances, find themselves in a difficult legal dilemma as to their duty of care towards others. A suspended doctor may risk litigation if they are unaware of the legal ramifications of their unusual circumstances. The following article outlines the legal situation as it applies to England and Wales. (+info)